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B. OCCUPATIONAL HISTORY TABLE

Complete the following table showing the entire work history of the individual from present to initial employment. Sporadic, part-time periods of employment, each of no significant duration, should be grouped if possible.

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12. Did you bring up (more) phelgm than usual in any 1 Yes 20 No

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27. Are you ever troubled by shortness of breath, when
hurrying on the level or walking up a slight hill? 1 C
If NO, grade is 1. If YES, proceed to next question
28. Do you get short of breath walking with other
people at an ordinary pace on the level?

Yes 2 No

10 Yes

2 No

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